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It wasn’t until the last two decades that doctors began to understand the importance of treating the mental health concerns of patients with cancer. Research shows that when patients receive mental health support in addition to medical treatment, their overall quality of life improves. Conversely, depression is linked to lower survival rates for many cancers. Now, psychosocial oncology has become a subspecialty of oncology, with its own body of knowledge contributing to cancer care.
At the Stefanie Spielman Comprehensive Breast Center at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, doctors are using a team-based model of psychosocial oncology care. The Collaborative Care Model has amassed the most evidence among other interventions to demonstrate its effectiveness in improving clinical outcomes, access to services and patient satisfaction.
The Spielman Breast Center started the Collaborate Care Program in November 2018 to respond to a shortage of mental health professionals to care for their patients.
“Our patients didn’t have months to wait. They were in active cancer treatment and needed timely access to mental health services,” says Kevin Johns, MD, psychosocial oncology medical director.
The Collaborative Care Program deploys a team that includes a medical oncology provider, Dr. Johns and social workers from the medical oncology clinic. These social workers are the key to the success of the team.
“They are my eyes and ears,” Dr. Johns says. “They do each patient’s intake and history and immediately start appropriate behavioral health interventions. Then, at a weekly care conference, they review each patient’s chart with me. We decide on further treatment and interventions for each patient as a team. We also keep the medical oncology team updated with any changes in health status or treatment plans.”
The social workers meet with each patient as needed and report to the team if a different form or higher level of care is necessary. They can also refer patients to the nurse practitioner or others in the department for additional testing or care.
While every patient with breast cancer is screened for depression and anxiety, the Collaborative Care Program is only available to patients in active cancer treatment who don’t already have a mental health provider. The model’s success is based on regular meetings with the team and patient.
Promising results
In 2020, Dr. Johns published an abstract of a study of 74 patients enrolled in the program between November 2018 and January 2020. These patients underwent endocrine therapy, chemotherapy, single-agent HER2 inhibitor targeted therapy, immunotherapy, single-agent CDK4/6 inhibitor therapy and radiation for their cancer.
At the end of the study period, patients reported a 40% decrease in depression symptoms and a 36% decrease in anxiety symptoms, on average. In addition, the average patient satisfaction score was 4.3 on a scale of 1 to 5, and the average medical oncology satisfaction score was 4.6. The program was also deemed financially viable because reimbursements covered 52% of psychiatry costs for care, and the program’s existing social workers served as care managers.
As of December 2022, 162 patients have received psychosocial oncology care through the Collaborative Care Program.
One patient’s story
Recently a patient was diagnosed with breast cancer soon after the unexpected death of her son. The patient exhibited symptoms of depression, anxiety and panic attacks. She was prescribed medications by her primary care physician but experienced only minimal relief. The patient was enrolled in the Collaborative Care Program. The team provided medication management, counseling and a safety plan.
However, during treatment, the patient became actively suicidal. She activated her safety plan by going to the nearest emergency department where she received acute mental health care and successfully returned home. She continued to work with the team and graduated from the Collaborative Care Program after her depression and anxiety symptoms improved.
The future of the Collaborative Care Program
This innovative model of mental health care is still relatively unknown to the medical community. However, studies have shown it to be very effective in treating mental health issues in patients with cancer. And the team approach gets patients in front of a mental health professional much faster, which can be critical in many cases.
“Many patients have mental health concerns throughout and beyond their cancer diagnosis and cancer-directed care. Efficient screening, work-up and implementation of patient-centered care are essential for optimizing both health and quality of life. The collaborative care model has been instrumental in providing this for my patients. The team-based approach allows for efficient evaluation, timely access to mental health resources and specialist recommendations regarding medication management,” says Ashley Pariser, MD, medical oncologist.
Dr. Johns is eager to work with other community-based medical oncologists interested in offering these interventions to their patients. “I know that patients with cancer often have a powerful bond with their oncologist. I’m not here to change that. I am here to support a patient’s treatment plan as needed. I’ll work with them and their team to get the best results,” he says.
